KEM hospital experience shows what unplanned medical expenses mean for the masses

Scarcity of resources in Mumbai's public hospitals like KEM Hospital results in heavy out-of-pocket expenditure for many seeking treatment here.

In late August, Deepak Khilare, 40, undertook a 12-hour journey of 600 km with his family of five, including his aged father and a 10-year-old son, to visit Mumbai’s King Edward Memorial (KEM) hospital from his hometown Nanded. A daily wage labourer, Deepak had sustained an injury while working at a construction site a month ago. This caused trauma to his spine and impaired his leg functions.

The family first admitted him to a private hospital, but little improvement in his condition and dwindling savings forced them to move him to KEM. The fact that Deepak’s relative was admitted there years ago and had returned home in better health gave them hope.

Read more: For patients’ families from rural Maharashtra, Dharamshalas in Mumbai offer a community of care

An expensive journey with little result

At the hospital, the family was asked to get an MRI done before the doctor’s consultation. However, the hospital only has one MRI machine at the moment.

“When we went to the lab here, they told us there’s a waiting time and asked us to wait till March. Only after we pleaded and explained our long journey did they give us an MRI appointment for September 30th,” says Kishore Khilare, Deepak’s younger brother who is also a daily wage worker.

“We most certainly have too much of workload. We have asked for another MRI machine a year ago but it has not arrived yet. It will take time for that,” says the dean of KEM Dr Sangeeta Ravat.

Meanwhile, Deepak’s family had spent nearly Rs 12,000 within two days of undertaking the journey. These were the expenses they had come prepared for, like the bus travel and food. “He (Deepak) is unable to walk so we need to use a wheelchair everywhere. We have had to spend a lot of money on taxis, travel and food up till now,” says Kishore.

But what they had not expected was the additional expenses at the hospital. “Our income has stopped as we are daily wage earners. We borrowed a large sum from a money lender for this trip,” Kishore adds. Staying in the city for longer was not feasible.

The Khilare family ultimately decided to get the MRI done at a private facility; there are many private labs opposite the hospital but while an MRI at KEM and other civic-run hospitals costs Rs 2,500, the same costs nearly Rs 10,000 when done at a private lab.

A teary-eyed Deepak outlined how the journey cost his family Rs 30,000, including the fare for their return journey, during the seven odd days they spent at KEM. A follow-up in a month was advised.

When asked why the family did not avail healthcare at a government hospital in their hometown of Nanded, Kishore said, “It is our understanding that there is no treatment available for patients with severe spine injury at our public hospitals. Only private hospitals offer such treatment there.”

A public healthcare crisis

On average, around 10,000 patients visit KEM for various medical services daily. It has also had troubles with the in-house CT scan machines, and despite a request to Brihanmumbai Municipal Corporation (BMC) for a new one, they are yet to receive a new machine. “One of the two CT scan machines is very old and sometimes doesn’t work while the other had to undergo repairs. After undergoing repairs, both the machines are working at the moment,” says Dr Ravat.

An image of KEM hospital's main gate. A crowd is walking around within the hospital premises, navigating through the space.
Navigating the hospital premises is not an easy task for patients. Patients and their families asking for directions while rushing from one department to another is a very common sight at KEM and other public hospitals. Pic: Eshan Kalyanikar

Like the Khilares, many across the country travel long distances in search of better healthcare that is unavailable in their small towns and villages. According to the National Sample Survey Organisation (NSSO) on domestic tourism in India (2014-15), a total of 36.6 million health-related trips were made within the country, including travel within the home district and to other districts in the home state as well as in other states. In Mumbai itself, over 30% of people in Mumbai’s government hospitals come from rural areas of Maharashtra and other states.

Like KEM, Sion Hospital too suffers from a shortage of MRI machines. The hospital has two at the moment. “One of them has lived its life, we do about 25 MRIs per day. It is a lengthy process taking about 45 minutes, unlike CT scans. We do about 150 CT scans every day,” says hospital Dean Dr Mohan Joshi. He adds that the Sion Hospital sees a demand of roughly 100 MRIs on daily basis.

More money is needed for peripheral hospitals

Dr Joshi contends that an ideal solution would be to strengthen peripheral hospitals. A peripheral hospital is designed to provide a wide range of services across various departments, including gynaecology, surgery, trauma care, orthopaedic, and ENT. The idea is to allow main civic hospitals to cater to speciality cases.

Mumbai has a total of 16 peripheral hospitals, 175 municipal dispensaries and four civic-run hospitals. “We are soon going to have 3-tesla MRI machines in Sion as well as Nair hospital. It was supposed to be a 1.5-tesla machine earlier but even after tenders were floated six to seven times, nobody responded”, says BMC’s Additional Commissioner of Health Dr Sanjeev Kumar. Dr Kumar also is trying to have better equipped dispensaries and more HBT (Hridaysamrat Balasaheb Thackeray) clinics. So those who come for routine follow ups can be directed to the peripheral hospitals.

Dr Kumar says the HBT clinic and dispensary improvement process will help to reduce the crowd at hospitals like KEM and Sion. “The work to strengthen our infrastructure is on. But facilities like Primary Health Centres in Maharashtra and other states need to improve so that our healthcare system here (in Mumbai) is not overburdened,” he says.

Doctors themselves seem to be taking on the burden of gaps in healthcare. “We are starting a centre, in Public Private Partnership mode, in Dharavi for MRIs and CTs. It will have one CT scan and one MRI scan. That will help us as the centre will take care of another 25-30 MRIs every day. It should be ready by 1st January or 1st February,” says Dr Joshi.

A board in Marathi, that translates to: Brihanmumbai Municipal Corporation's Visava by Tanvi Nagri Seva Sahakari Sanstha.
Situated within KEM premises, accommodation is provided at Visava to the relatives of out-station patients who are admitted at KEM. The facility has limited capacity. Pic: Eshan Kalyanikar

“Out-of-pocket expenses in theory and practice assume that the patient is an in-patient, meaning that they are already hospitalised. But in India, becoming an in-patient is very difficult because the infrastructure is in shambles. If one is not an in-patient, the facilities that come included in hospital expenses such as food, stay, medicines are not taken care of and the person trying to avail healthcare has to spend large sums on them,” says Deeksha, a PhD Scholar at the Tata Institute of Social Sciences, whose area of study is migration, public health and cities in India.

When asked if the situation would be better for the residents of Mumbai as well as for visiting patients like Deepak a few months down the line, Dr Kumar says, “It is a long process but we hope things will improve over a period of time.”

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